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Treatment of Scrupulosity-Related Obsessive-Compulsive Disorder

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Clinical Handbook of Obsessive-Compulsive and Related Disorders

Abstract

Scrupulosity is a manifestation of obsessive-compulsive disorder in which obsessional fears or compulsive rituals are religious or moral. Clinicians often struggle working with scrupulous individuals. Clinicians must disentangle religious from compulsive ritual and help patients violate the latter but not the former, which often involves becoming acquainted with unfamiliar and complex religious norms and working collaboratively with clergy. Therefore, effective exposure and response prevention (ERP) requires skilled psychotherapy technique and creativity along with cultural sensitivity and respect of patient values. In this chapter, we illustrate the application of ERP for scrupulosity with the case of David. We highlight issues related to psychoeducation, the therapeutic stance, motivational and cognitive work, and both in vivo and imaginal exposures. Throughout, we elaborate on clinical decision-making processes that guide treatment.

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Notes

  1. 1.

    Subjective units of distress, used as shorthand to gauge degree of anxiety from 0 (none) to 10 (extreme).

  2. 2.

    It is important to note that many individuals who suffer from scrupulosity do not describe having ultimate fears of eternal damnation or divine punishment, per se. For many, simply living in a feeling of a state of sin is simply unacceptable. At times, there are fears that there will be “punishments in this world if not in the world to come,” but even this is not uniform.

References

  • Abramowitz, J. S. (2001). Treatment of scrupulous obsessions and compulsions using exposure and response prevention: A case report. Cognitive and Behavioral Practice, 8, 79–85.

    Article  Google Scholar 

  • Abramowitz, J. S., Huppert, J. D., Cohen, A. B., Tolin, D. F., & Cahill, S.P. (2002). Religious obsessions and compulsions in a non-clinical sample: The penn inventory of scrupulosity. Behavior Research and Therapy, 40, 825–838.

    Article  Google Scholar 

  • Abramowitz, J. S., Franklin, M. E., Schwartz, S. A., & Furr, J. M. (2003). Symptom presentation and outcome of cognitive-behavioral therapy for obsessivecompulsive disorder. Journal of Consulting and Clinical Psychology, 71, 1049–1057.

    Article  PubMed  Google Scholar 

  • Alonso, P., Menchon, J. M., Pifarre, J., Mataix-Cols, D., Torres, L., Salgado, P., et al. (2001). Long-term follow-up and predictors of clinical outcome in obsessive-compulsive patients treated with serotonin reuptake inhibitors and behavioral therapy. Journal of Clinical Psychiatry, 62, 535–540.

    Article  PubMed  Google Scholar 

  • American Psychiatric Association (2000). Diagnostic and statistical manual of psychiatric disorders (4th ed., text revision). Washington, DC: American Psychiatric.

    Google Scholar 

  • Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck depression inventory-II. San Antonio: Psychological Corporation.

    Google Scholar 

  • Besiroglu, L., Karaca, S., & Keskin, I. (2014). Scrupulosity and obsessive compulsive disorder: The cognitive perspective in Islamic sources. Journal of Religion and Health, 53, 3–12.

    Article  PubMed  Google Scholar 

  • Bonchek, A. (2009). Religious compulsions and fears: A guide to treatment. Jerusalem: Feldheim.

    Google Scholar 

  • Bonchek, A., & Greenberg, D. (2009). Compulsive prayer and its management. Journal of Clinical Psychology, 65, 396–405.

    Article  PubMed  Google Scholar 

  • Burns, D. D. (1980). Feeling good: The new mood therapy. New York: Signet.

    Google Scholar 

  • Ciarrocchi, J. W. (1995). The doubting disease: Help for scrupulosity and religious compulsions. Mahwah: Paulist.

    Google Scholar 

  • Deacon, B., & Nelson, E. A. (2008). On the nature and treatment of scrupulosity. Pragmatic Case Studies in Psychotherapy, 4, 39–53.

    Article  Google Scholar 

  • Deacon, B. J., Vincent, A. M., & Zhang, A. R. (2013). Lutheran clergy members’ responses to scrupulosity: The effects of moral thought-action fusion and liberal vs. conservative denomination. Journal of Obsessive-Compulsive and Related Disorders, 2, 71–77.

    Article  Google Scholar 

  • Eisen, J. L., Goodman, W. K., Keller, M. B., Warshaw, M. G., DeMarco, L. M., Luce, D. D., et al. (1999). Patterns of remission and relapse in obsessive-compulsive disorder: A 2-year prospective study. Journal of Clinical Psychiatry, 60, 346–351.

    Article  PubMed  Google Scholar 

  • Ferrão, Y. A., Shavitt, R. G., Bedin, N. R., De Mathis, M. E., Lopes, A. C., Fontenelle, L. F., et al. (2006). Clinical features associated to refractory obsessivecompulsive disorder. Journal of Affective Disorders, 94, 199–209.

    Article  PubMed  Google Scholar 

  • Foa, E. B., & Kozak, M. J. (1985). Treatment of anxiety disorders: Implications for psychopathology. In A. H. Tuma & J. D. Maser (Eds.), Anxiety and the anxiety disorders (pp. 421–452). Hillsdale: Erlbaum.

    Google Scholar 

  • Foa, E. B., & Kozak, M. J. (1995). DSM-IV field trial: Obsessive-compulsive disorder. The American Journal of Psychiatry, 152, 90–96.

    Article  PubMed  Google Scholar 

  • Foa, E. B., Huppert, J. D., Leiberg, S., Langner, R., Kichic, R., Hajcak, G., et al. (2002). The obsessive-compulsive inventory: Development and validation of a short version. Psychological Assessment, 14, 485–496.

    Article  PubMed  Google Scholar 

  • Franklin, M. E., & Foa, E. B. (2014). Obsessive-compulsive disorder. In D. H. Barlow (Ed.), Clinical handbook of psychological disorders: A step-by-step treatment manual (5th ed., pp. 155–205). New York: Guilford.

    Google Scholar 

  • Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleischmann, R. L., Hill, C. L., et al. (1989). The Yale–Brown obsessive compulsive scale, I: Development, use, and reliability. Archives of General Psychiatry, 46, 1006–1011.

    Article  PubMed  Google Scholar 

  • Greenberg, D., & Huppert, J. D. (2010). Scrupulosity: A unique subtype of obsessive-compulsive disorder. Current Psychiatry Reports, 12, 282–289.

    Article  PubMed  Google Scholar 

  • Greenberg, D., & Shefler, G. (2002). Obsessive compulsive disorder in ultra-orthodox Jewish patients: A comparison of religious and non-religious symptoms. Psychology and Psychotherapy: Theory, Research and Practice, 75, 123–130.

    Article  Google Scholar 

  • Greenberg, D., & Shefler, G. (2008). Ultra-orthodox rabbinic responses to religious obsessive-compulsive disorder. Israel Journal of Psychiatry and Related Sciences, 45, 183–192.

    PubMed  Google Scholar 

  • Huppert, J. D., & Siev, J. (2010). Treating scrupulosity in religious individuals using cognitive-behavioral therapy. Cognitive and Behavioral Practice, 17, 382–392.

    Article  Google Scholar 

  • Huppert, J. D., Siev, J., & Kushner, E. S. (2007). When religion and obsessive-compulsive disorder collide: Treating scrupulosity in Ultra-Orthodox Jews. Journal of Clinical Psychology, 63, 925–941.

    Article  PubMed  Google Scholar 

  • Mataix-Cols, D., Marks, I. M., Greist, J. H., Kobak, K. A., & Baer, L. (2002). Obsessive-compulsive symptom dimensions as predictors of compliance with and response to behaviour therapy: Results from a controlled trial. Psychotherapy and Psychosomatics, 71, 255–262.

    Article  PubMed  Google Scholar 

  • Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd ed.). New York: Guilford.

    Google Scholar 

  • Okasha, A., Saad, A., Khalil, A. H., El Dawla, A. S., & Yehia, N. (1994). Phenomenology of obsessive-compulsive disorder: A transcultural study. Comprehensive Psychiatry, 35, 191–197.

    Article  PubMed  Google Scholar 

  • Pinto, A., Eisen, J. L., Mancebo, M. C., Greenberg, B. D., Stout, R. L., & Rasmussen, S. A. (2007). Taboo thoughts and doubt/checking: A refinement of the factor structure for obsessive-compulsive disorder symptoms. Psychiatry Research, 151, 255–258.

    Article  PubMed Central  PubMed  Google Scholar 

  • Rasmussen, S. A., & Tsuang, M. T. (1986). Clinical characteristics and family history in DSM-III. Obsessive-compulsive disorder. American Journal of Psychiatry, 143, 317–322.

    Article  PubMed  Google Scholar 

  • Rufer, M., Grothusen, A., Maß, R., Peter, H., & Hand, I. (2005). Temporal stability of symptom dimensions in adult patients with obsessive-compulsive disorder. Journal of Affective Disorders, 88, 99–102.

    Article  PubMed  Google Scholar 

  • Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., et al. (1998). The mini-international neuropsychiatric interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59, 22–33.

    PubMed  Google Scholar 

  • Siev, J., Baer, L., & Minichiello, W. E. (2011). Obsessive-compulsive disorder with predominantly scrupulous symptoms: Clinical and religious characteristics. Journal of Clinical Psychology, 67, 1188–1196.

    Article  PubMed  Google Scholar 

  • Tolin, D. F., Abramowitz, J. S., Kozak, M. J., & Foa, E. B. (2001). Fixity of belief, perceptual aberration, and magical ideation in obsessive-compulsive disorder. Journal of Anxiety Disorders, 15, 501–510.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Center for Psychological Studies, Nova Southeastern University, Maltz Psychology Building, 3301 College Avenue, 33314, Fort Lauderdale, FL, USA

    Jedidiah Siev PhDPhD

  2. The Hebrew University of Jerusalem, Jerusalem, Israel

    Jonathan D. Huppert

Authors
  1. Jedidiah Siev PhDPhD
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  2. Jonathan D. Huppert
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Correspondence to Jedidiah Siev PhDPhD .

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Editors and Affiliations

  1. Department of Pediatrics, Health Policy & Management, Psychiatry & Behavioral Neurosciences, and Psychology, University of South Florida, St. Petersburg, Florida, USA

    Eric A. Storch

  2. Departments of Pediatrics, Psychiatry and Psychology, University of South Florida, Tampa, Florida, USA

    Adam B. Lewin

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Siev, J., Huppert, J. (2016). Treatment of Scrupulosity-Related Obsessive-Compulsive Disorder. In: Storch, E., Lewin, A. (eds) Clinical Handbook of Obsessive-Compulsive and Related Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-17139-5_4

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